Rehabilitation, Restrictions, and Return to Sport After Cartilage Procedures

The ability to return to sport (RTS) after articular cartilage injury is of vital importance to athletes. Discussing the likelihood of returning to sport with patients is necessary, yet patients should be informed of the heterogeneous nature of the variables associated with successful RTS. 

What To Know 

• Patient-specific factors affecting RTS are numerous and, in most cases, their isolated effect on RTS rates have yet to be examined and will remain difficult to do so 
• Physical Therapy protocols after cartilage procedures, including microfracture, osteochondral allograft transplantation (OCA), autologous chondrocyte implantation (ACI), are unique and necessitate different parameters 

Which Procedure is Best? 

The indication for each procedure is dependent on multiple factors, for example, defect size and defect location.

What is Microfracture? 

• A single-stage procedure which generates a fibrocartilage repair tissue rather than restore or regenerate the native surface with hyaline cartilage. 
• A viable first-line option for management of symptomatic cartilage lesions, especially if the lesion is <2 cm2 

Microfracture Rehab 

• Microfracture performed on the femoral condyle 
• Non-weightbearing x 6-weeks 
• Brace is locked in full extension at all times, with exception for non-weightbearing exercises (passive leg hangs, quad sets, and calf pumps). 
• Continuous passive range of motion (CPM) begins immediately after surgery with progression to active assisted range of motion (AAROM) exercises in week 2, as tolerated 
• Patellofemoral defects (not performed with a concomitant tibial tubercle realignment procedure) are allowed to weight bear as tolerated immediately with the brace locked. 
• Full Protocol

What is Osteochondral Allograft Transplant? 

• Osteochondral allografts (OCAs) are an effective way to treat cartilage damage, especially in young, active adults. 
• OCAs restore hyaline cartilage to the articular surface through the transplantation of donor cartilage. 
• It is a one-stage procedure that typically treats larger (>2 cm2), full-thickness osteochondral defects.
  

Osteochondral Allograft Transplant Rehab 

• For femoral condyle defects, heel touch weightbearing x 6 weeks after surgery, then patients progress to full weightbearing as tolerated. 
• For the first 2 weeks after OCA, a brace is locked in full extension between sessions of CPM and non-weightbearing exercises. 
• After postoperative week 2, the patient may begin advancing through PROM and AAROM, as tolerated.
• Full Protocol
   

What is MACI? 

• Matrix-induced autologous chondrocyte implantation or MACI utilizes the patient's own cells to regrow new cartilage for the defect.  
• It is a 2-part procedure:  
• The first procedure includes a cartilage biopsy performed arthroscopically. The biopsy is sent to the lab to grow. 
• Next, when the cartilage is ready for implantation, it is size-matched to fit the defect in the knee joint.   

MACI Rehab 

• After MACI, patients are non-weightbearing until week 6 after surgery; then patients progress to full weightbearing as tolerated. 
• Similar to OCA, patients will be kept exclusively in a brace locked in full extension for the first 2 weeks, with exceptions made only for non-weightbearing exercises and CPM. 
• Patients are started on PROM and AAROM, as tolerated, after the knee brace is removed during postoperative week two. 
• Patellofemoral lesions that are not performed with a concomitant tibial tubercle realignment procedure are allowed to bear weight as tolerated immediately with initial use of the brace over the first 6 weeks after surgery. 
• Full Protocol